February 23, 2024

Managing miracle expectations in clinical medicine

What do you do when someone expects a medical miracle?

Despite the increasingly atheistic nature of Western countries, many people still believe in miracles. In particular, statistics indicate that many people still believe in medical miracles. What’s more, the cases of terminally ill British infants Charlie Gard and Alfie Evans arguably are examples of parents “holding out for a miracle”.

How then, should hospital ethicists respond to miracle invocations by surrogate decision makers?

A new article in the American Journal of Bioethics attempts to provide guidelines for hospital ethicists in their interactions with religious (particularly, Christian) surrogate decision makers. Three American medical researchers — Trevor M. Bibler (Baylor), Myrick C. Shinall Jr. (Vanderbilt) and Devan Stahl (Michigan State) — offer “a taxonomy of miracle invocations”, ranging from more personal, authentic invocations of the divine to invocations motivated by a distrust and a loss of faith in the healthcare team treating a patient. They argue that, regardless of what the motivation of the miracle invocation is, clinical ethicists need to exercise show “empathy” and “epistemic humility” when engaging with decision makers:

The model of inquiry we promote paints the ethicist as an open-minded and active collaborator in another’s search for truth…Some ethicists may reject this portrait, but patients’ moral systems often include religious beliefs to which the ethicist must respond—or risk ignoring moral, spiritual, and existential distress…The ethicist’s ability to clarify seemingly opaque concepts, promote precise communication, and elucidate values seems especially important when religious concepts orient a patient’s worldview.

Several commentators respond to the target article, with some suggesting that it falls outside of the role of the ethicist to explore and “shore up” the moral worldview of surrogate decision makers. Some believe that it is the role of chaplains and pastoral care workers to interact with patients at this level.

Managing miracle expectations in clinical medicine
Xavier Symons
Creative commons
medical ethics